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Clinical features and management of multifocal hepatic hemangiomas in children: a retrospective study
Yi Ji1, Siyuan Chen2, Bo Xiang1
1Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China.
Abstract:
Multifocal hepatic hemangioma (MHH) is a benign hepatic tumor that is commonly diagnosed in children with multiple cutaneous infantile hemangiomas (IHs). We present a review of all children with MHH at our institutions. Of the 42 patients, the median age at presentation of MHH was 2.5 months. Thirty-six (85.7%) patients had cutaneous IHs. Twelve (28.6%) patients were symptomatic at presentation. There was no significant association between the number of hepatic hemangiomas and the number of cutaneous IHs. Fourteen (33.3%) patients received some form of treatment for hepatic hemangiomas. The most common type of treatment was oral prednisone in 8 patients, followed by oral propranolol in 6 patients. Two patients were totally resistant to prednisone treatment. They died from congestive heart failure or respiratory distress and coagulopathy. Two patients with problematic facial IH were treated with intralesional triamcinolone injection. The remaining 26 patients were managed with imaging surveillance. On follow-up, all of the survivors had a favorable outcome. Our study suggests that the clinical features of MHH are variable. Our data emphasize the treatment strategy that aggressive treatment is indicated in symptomatic or progressive MHHs, whereas observation management of asymptomatic patients with a few small lesions is safe and appropriate.
Insights
Multifocal hepatic hemangioma (MHH) in children often presents with skin lesions. Aggressive treatment is recommended for symptomatic cases, while asymptomatic MHH can be safely monitored.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Dermatology
Background:
- Multifocal hepatic hemangioma (MHH) is a benign liver tumor frequently seen in infants.
- MHH often co-occurs with multiple cutaneous infantile hemangiomas (IHs).
Purpose of the Study:
- To review clinical features, treatment strategies, and outcomes of pediatric patients with MHH.
- To evaluate the association between MHH and cutaneous IHs.
- To guide management decisions for MHH based on clinical presentation and disease progression.
Main Methods:
- Retrospective review of pediatric patients diagnosed with MHH at institutional centers.
- Analysis of patient demographics, clinical presentation, presence of cutaneous IHs, and treatment modalities.
- Assessment of treatment response, complications, and long-term outcomes.
Main Results:
- 42 pediatric patients with MHH were analyzed; median age at presentation was 2.5 months.
- 85.7% of patients had associated cutaneous IHs, but no significant association was found between the number of hepatic and cutaneous lesions.
- 12 patients (28.6%) were symptomatic; 14 patients received treatment (oral prednisone, oral propranolol, intralesional triamcinolone). Two patients resistant to prednisone died.
- 26 patients were managed with surveillance, and all survivors had favorable outcomes.
Conclusions:
- Clinical presentation of MHH in children is variable.
- Symptomatic or progressive MHH warrants aggressive treatment.
- Asymptomatic MHH with small lesions can be safely managed with observation and surveillance.
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